GEOFFREY C. FENNER, MD THOMAS A. MUSTOE, MD
In contrast to the 1960s when silicone implants were the mainstay of breast reconstruction, patients in the 1990s may choose from an impressive spectrum of reconstructive options. Techniques, instruments, and materials have evolved that provide all patients, regardless of age, stage, previous treatment, or laterality, choices that may optimally represent their desires and expectations. Breast cancer awareness has increased the sophistication of patients, however, it remains the plastic surgeon's responsibility to educate patients and coordinate expectations and outcome.
Increased detection of breast cancer has paralleled improved techniques and availability of screening mammography, an increased female population, and the impact of changes in the age of childbearing, menarche, and menopause. Today, ductal carcinoma in situ (DCIS) represents 15 to 20 percent of all breast cancer cases;1 it is treated by either localized resection or total mastectomy. Genetic testing and better elucidation of risk factors has identified additional patients as potential candidates for prophylactic mastectomy. As many as 15 percent of patients undergoing breast conservation, and who require a proportionately large lumpec-tomy, attain poor esthetic outcome and may be better served in the longterm, by preoperative consideration of completion mastectomy and autologous reconstruction.2 Included in this group are patients with small breasts, proportionately large lesions, and centrally located lesions. These women, often having been diag nosed at an earlier age and stage, have excellent prognoses, and represent an increasing percentage of patients seeking consultation and alternatives for breast restoration.
The female breast is intimately associated with a woman's selfesteem, sexuality, and interpersonal relations. The response to the impact and presumed implications of breast cancer varies widely among women. Breast cancer represents a therapeutic myriad with emotional and physical implications, both for the present and future. Although breast reconstruction may be viewed as a positive alternative to breast loss, it represents only one facet newly diagnosed cancer patients must face. Each patient upholds an individual, often rigid, esthetic standard, emotional drive, and physiology which guides them towards a specific reconstructive technique. It remains the plastic surgeon's responsibility to inform, educate, and perform with this in mind.
The first breast reconstruction was performed by Czerny, in 1895, when he successfully transplanted a lipoma from a patient's flank to a submammary position.3 Multiple developments over the past 100 years have improved reconstructive options as well as ultimate outcomes for women faced with mastectomy.
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